CITY OF FORT COLLINS
                                                                            DEPARTMENT OF FINANCE / SALES TAX DIVISION
                                                                            P.O. BOX 440   FORT COLLINS, CO  80522-0439
                                                                            PHONE 970-221-6780   FAX 970-221-6782                      LODGING TAX RETURN
                                                                            E-MAIL  salestax@fcgov.com
                                                                                                                            COMPUTATION OF TAX
                                                                                            5. AMOUNT OF CITY LODGING TAX:               3% OF LINE 4
PERIOD                                           DUE                          ACCT.#
COVERED                                          DATE                                       6. ADD: EXCESS TAX COLLECTED
1.  GROSS SALES (TOTAL RECEIPTS FROM CITY ACTIVITY MUST BE                                  7. ADJUSTED CITY TAX (ADD LINES 5 AND 6)
    AND SERVICE   REPORTED AND ACCOUNTED FOR IN EVERY RETURN 
                  INCL. ALL SALES, RENTALS, AND
                  LEASES AND ALL SERVICES BOTH TAXABLE AND NON-                             8.           RETAILER'S FEE HAS BEEN ELIMINATED FOR TAXES  
                  TAXABLE.)                                                                                                      COLLECTED ON OR AFTER 1/1/2010 
2A. ADD: BAD DEBTS COLLECTED
2B. TOTAL LINES 1 & 2A                                                                      9. TOTAL LODGING TAX (LINE 7)
3.  A. NON-TAXABLE                  (INCLUDED IN                                                                         PENALTY:10%                                  ENTER
       SERVICE                      ITEM 1 ABOVE)                                           10.          LATE FILLING                                                  TOTAL
    B. SALES TO OTHER LICENSED                                                                  IF RETURN IS FILED       INTEREST      1%
       DEALERS FOR PURPOSES OF                                                                           AFTER DUE DATE  PER MONTH: 
    C. SALES SHIPPED TAXABLE RESALE (INCLUDED IN                                                                                                                $25.00
                                                                                                         THEN ADD:       ASSESSMENT FEE
D      OUT OF CITY                  ITEM 1 ABOVE)                                           11. TOTAL TAX DUE AND PAYABLE ( ADD LINES 9 AND 10
       AND/OR STATE
E   D. BAD DEBTS     (ON WHICH CITY 
D      CHARGED       SALES TAX HAS                                                          12. ADJUSTMENTS FOR PRIOR PERIODS - ATTACH 
       OFF                          BEEN PAID)
U   E. TRADE-INS FOR TAXABLE                                                                    COPY OF NOTICE
C      RESALE                                                                               13. TOTAL DUE AND PAYABLE:               MAKE CHECK OR MONEY ORDER
T   F. SALES OF GASOLINE                                                                                                                 PAYABLE TO:
I      AND CIGARETTES                                                                                                                CITY OF FORT COLLINS
O   G. SALES TO GOVERNMENTAL,                                                               SCHEDULE A
N      RELIGIOUS AND CHARITABLE 
S      ORGANIZATIONS
    H. RETURNED GOODS
    I. PRESCRIPTION DRUGS / 
       PROSTHETIC DEVICES
    J. Food Stamps
    K. Lodging Over 30 days
    L. Grocery Food Sales
    M. Other
    3. TOTAL DEDUCTIONS                          (TOTAL OF LINES 3
                                                  A THRU M)
4. TOTAL CITY NET TAXABLE SALES & SERVICES                  (LINETOTAL2BLINEMINUS3)
NEW BUSINESS DATE                   1.  If ownership has changed, give date of change and   SHOW BELOW CHANGE OF OWNERSHIP, NAME     I, hereby certify, under penalty of perjury, that the 
                                         new owner's name.                                  AND/OR ADDRESS, ETC                   statements made herein are to the best of my knowledge 
MO. DAY    YEAR                     2.  If business has been permanently discontinued, give                                                                     true and correct.
                                         date discontinued.                                 ________________________________
_______________                     3.  If business location has changed, give new address. ________________________________      BY:___________________________________________
DISCONTINUED DATE                   4.  Records are kept at what address?                   ________________________________
                                     ________________________________
MO. DAY    YEAR                     5.  If business is temporarily closed, give dates to be ________________________________      COMPANY:____________________________________
                                         closed.                                                                                  PHONE:_______________________________________
_______________                     6.  If business is seasonal, give months of operation.
                                    7.  If this return includes sales for more than one     BUS. ADDRESS MAILING ADDRESS          ________________________           _________________
                                         location, refer to and complete schedule "C".                                                           TITLE                                              DATE